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Why Long-Term Disability Applicants Get Denied

If you are injured and unable to go to work for long periods of time, the expectation is that you will qualify for disability benefits. The Employee Retirement Income Security Act, or ERISA, governs those long-term disability policies that are made available by an employer. It also makes sure that any disability application will be reviewed by a claims administrator that is issued by your insurance provider. Even when proof of disability is clear, though, there are times when a request is denied. This guide will look at why this happens and how a California long term disability lawyer can help.

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Lack of Medical Evidence For Disability

One of the primary reasons a disability claim is rejected is due to not having enough evidence to support benefits. To prevent this, make sure to have these with you:

  • Notice of regular medical treatment: Your insurance company will expect you to make any regular visits to a physician or other care specialist. If there was a physical injury, objective tests should be completed by your doctor, which includes x-rays, CT scans and MRIs as needed.
  • Missing medical records: The insurance company not having access to all your records can lead to having a claim denied. This can be prevented by checking with the disability carrier to ensure all reports are in their possession and checking with insurance to have any needed documents sent.
  • Statement from your doctor: You or your attorney need to ask your doctor to provide detailed information on how your injury is preventing you from performing work-related operations. These are better than having just data from the insurance company, as these can lead to responses that support denial of the claim.

Video Surveillance and Policy Definitions

If you are filing a long-term disability claim, if should be noted that investigators may follow you for video surveillance via request from your insurance company. These investigators will usually look for the filer to be doing tasks that aren’t consistent with a disability claim. There are cases where evidence found on video can lead to disapproval of disability benefits.

In addition, a patient should check with their issued policy and review the summary of a disability definition to verify it can be met. There are two types to note: “own occupation” policies means your disability prevents you from performing your specific job, while “any occupation” applies to any type of work.

Not Paying Attention To Long Term Disability Deadlines

Make sure to note any deadlines that are associated with the filing of your claim. The majority of individual plans and all group plans covered by ERISA allow for 180 days to appeal a first denial. If that timeframe elapses, you will not be able to sue the insurance company in federal court as you did not use administrative appeals. It’s best to file immediately, then hire a long-term disability lawyer to help with medical records and other documentation.

The Role Of A California Long Term Disability Lawyer

It can be easy to lose out on long-term disability if you’re not careful. Following the advice of your doctor and obtaining all associated records can help prevent this, as well as counting on a reliable long term disability lawyer. We’ve been helping disabled individuals in the Greater Los Angeles area, the Inland Empire, and Orange County get the disability benefits they need for years. Call Dr. Bill LaTour and his team today at 800-803-5090  or fill out our online form to schedule a free consultation.